I’m a self-proclaimed process nerd.
As an MBA recipient in Management Systems, I’m very familiar with concepts like Lean Process, Six Sigma and other improvement methodologies. These processes are all concerned with designing and controlling processes for optimal efficiency (the “how-to”), and not so much about the implementers of those processes.
For that information, I recently took a course through MIT Sloan called Business Process Design for Strategic Management. Much of the content focused on what’s referred to as ‘Dynamic Work Design,’ which focuses on how the people involved in carrying out the work handle their tasks.
I couldn’t help but see the potential for greater success by deploying this type of process design to medical practices. Let me explain.
When we look at, say, lean principles, we can see plenty of opportunity to better design workflows in order to save time, cut out redundancy, and improve productivity. This concept works beautifully in machine-based environments, where there is a reasonable measure of confidence that processes will remain fairly static, routine and repeatable. But applied to service-based industries – like medical practices – we see high variability in outcomes because there is less consistency in terms of repeatable processes. The reasons why are usually due to human interaction. Machines are great at doing the same task over and over; introduce human interactions to the mix, and you now have inputs and outputs of much higher variability.
Queue Dynamic Work Design. This is primarily concerned with focusing on the motivations and performance of the individuals conducting the work, as well as looking at who should be involved in problem-solving and escalation. By putting the focus on humans, their skills and adaptability, this methodology allows work to be designed around an organization’s most valuable resource: its people.
Three Types of Design
In order to see why this is concept is really appealing to me to apply to medical practices, an understanding of the two more typical forms of design should be made clear:
- ‘Process design’ – this is typically concerned with mapping out the major steps needed in order to, say, convert materials into a finished product or work through a project from start to finish along a timeline defined by a series of tasks.
- ‘Organization design’ – this typically focuses on the governance needs of organizations, addressing such things as reporting structures, resource responsibilities at various levels, and job assignments.
Neither takes into much account the actual human beings who are tasked with carrying out the work assigned by such designs. That’s where dynamic work design comes in.
‘Work design’ focuses on designing work that accounts for the skills and capabilities of those who need to carry out the tasks. Too often, work design is based on an “ideal” employee – in practice we know that such an employee rarely exists! Due to that reality, work design attempts to create work that recognizes people’s strengths and weaknesses and creates a basis for developing work that will engage and satisfy those tasked with carrying it out.
Specifically, work design seeks to meet three key criteria:
- Understanding outcomes: the person doing the work should understand why they are tasked with the work and be able to use a variety of skills in executing that work.
- Allowing individual control: people find tasks more engaging when they have at least some input or control over how it is carried out.
- Building a rapid feedback loop: people draw more satisfaction from tasks when they are not conducted in isolation. Receiving regular and rapid feedback on performance can be critical to keeping people motivated.
Now I am not suggesting that we throw out all the prior principles that have been used to subdivide and routinize tasks, as these approaches have continued to produce efficient results in practice. But, it would benefit us to look at better ways to bring people into the work equation, for two reasons: one, in service industries – like medical practices – our people’s performance is often how our practices are graded by our customers; and two, an engaged workforce allows for the development of appropriate organizational culture and the ability to deploy change more rapidly in a highly dynamic environment (see an article from the Summer Solstice 2017 issue, the ‘The Psychology of Disney: Get Intentional With Employee Engagement’ for more in that regard). And that’s where the ‘dynamic’ piece comes in.
On any given day at any medical practice there are scores of processes that are challenged in one way one or another. Checking in a patient at the front desk works fine most of the time: verify patient name, date of birth, insurance information, and so on. But what happens when a patient’s insurance eligibility comes back as ineligible? Or the patient left their insurance card at home? Or they do not have their copay amount? Or, or, or… What then? Static process steps for patient check-ins may be consistently challenged by other human beings not conforming to step-by-step processes when dealing with service-related matters. Practices therefore need to be thinking in terms of ‘static’ and ‘dynamic’ design when it comes to developing workflow processes across its organization.
- Static design is captured through process diagrams, project plans, and organizational charts, and readily identifying how things are supposed to work. We need these designs to provide the framework for how to get most jobs done.
- Dynamic design describes how a practice can respond when things don’t go as planned. And in medical practices, things do not go according to plan most of the time due to the unique nature of the patient-by-patient work.
That is, medical practices are much more dynamic than they are static, by nature. To operate efficiently and effectively in such environments, it is paramount to empower people to have control in terms of how they respond according to their own skill sets, and to give them an understanding of what goal it is that they are trying to accomplish, all of which lends itself to far superior customer service.
When employees ask why they are doing the work, they are better able to make the appropriate adjustments to the static design when dynamic challenges arise. As such, an effective work system can be viewed as everybody knowing why they are doing what they are doing, and results in creating an ongoing method for everyone to follow, from the manager to the receptionist. Those methods can constantly be compared and adjusted as needed in order to more perfectly align with the intended outcome. Honing processes in these ways will always produce far more superior results than trying to adhere to the principles of static design alone. When viewed from a ‘continuous improvement’ lens, you can see how examination of the static design compared to the reality of variability would produce a method for determining dynamic work design at your practice.
Over the course of the next few issues, I will be exploring how to develop this method in such a way that it can be readily deployed in the independent practice setting.